Provider Demographics
NPI:1245857002
Name:ROBERTSON, MORGAN ALESE (DNP)
Entity type:Individual
Prefix:DR
First Name:MORGAN
Middle Name:ALESE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:654 TARA LN
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-5818
Mailing Address - Country:US
Mailing Address - Phone:706-825-9075
Mailing Address - Fax:
Practice Address - Street 1:3614 J DEWEY GRAY CIR STE B
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6512
Practice Address - Country:US
Practice Address - Phone:465-170-6504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-28
Last Update Date:2022-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN269386363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty